Provider Demographics
NPI:1083740799
Name:DUGGAL, RAJENDARPAL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJENDARPAL
Middle Name:S
Last Name:DUGGAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:DUGGAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:119 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3714
Mailing Address - Country:US
Mailing Address - Phone:845-343-9919
Mailing Address - Fax:
Practice Address - Street 1:119 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3714
Practice Address - Country:US
Practice Address - Phone:845-343-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0348811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00747677Medicaid